There are more reasons than I can count why America's health care system needs to be overhauled - from stories of untreated illness and suffering to financial ruin and bankruptcy to tragically preventable deaths.

Not too long ago I wrote a commentary titled "113 million reasons why not." There are 113 million reasons why the most efficient and effective and fiscally responsible health care reform plan is considered "off the table" in Washington. They are the 113 million dollars given to candidates for federal office - in 2008 alone - by the industries that want to keep things the way they are.

I was telling only a small part of the story. Those same interests have made more than $2 billion in campaign contributions over the last decade. And they've spent more than $260 million on lobbying so far this year. There are six health care lobbyists for every member of Congress, and three new lobbyists register every day to influence the health care debate.

There's no greater need in America than health care reform. But health care reform worthy of the name remains terribly unlikely. In fact, it's terribly unlikely that the will of the people will be done on any of the biggest problems facing America unless we have a democracy worthy of the name. And we cannot have such a democracy so long as it is as seriously undernourished as ours is today.

Democracy is a living thing, and like all living things it requires sustenance. There are some things no true democracy can do without. Think of these as 12 minimum daily requirements, a basic subsistence diet:

1. Free speech. Not fee speech, free speech. The ability to be heard must be defended as vigorously as the right to speak.

2. A free and independent press. Maybe the digital age will one day force us to live without printed news. But it can't be allowed to make us do without journalism. Not if we are to have anything resembling a democracy.

3. Legitimate elections. The right to vote has to be jealously guarded. Voters need to be able to trust that every ballot is counted and counted properly. And we can't overlook the way political jurisdictions are drawn. Voters should choose their representatives, not the other way around. Oh, and one other thing: To be legitimate they need to be elections, not auctions.

4. Equal justice under the law. That means fair and impartial courts. And independent judges. Criminal justice cannot be an oxymoron in a democracy.

5. An ability to distinguish between democracy and commerce. In a democracy - or any just society - not every human interaction can be a commercial transaction.

6. An appreciation for and devotion to the commons. We can have a society where everything is privatized, or we can have a democracy, but we cannot have both.

7. Citizenship. There can be a ruling class, or there can be democracy, but there cannot be both.

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8. Civic education. Preparing our nation's young people to live in a democracy needs to be as front and center in school as preparing them to be economically productive.

9. A distribution of wealth sufficient to sustain a middle class. A democracy where the many work primarily for the excessive enrichment of a few is a democracy whose days are numbered.

10. Religious freedom and a separation of church and state - for the good of both religion and democracy.

11. Economic freedom and a separation of corporation and state. These two go hand in hand, though the current U.S. Supreme Court seems tone deaf to this truth. At a moment of corporate excess and irresponsibility not seen since the Gilded Age, our nation's highest court appears poised to rule that corporations do not have enough political clout and should be allowed to spend even more freely on elections.

12. Dissent. The highest form of patriotism. The ability and willingness to criticize every branch of our government at every level must never perish from our land. If it does, so does the very idea of democracy.

Ponder these staples for a moment, and you come to realize how poorly fed American democracy is at this moment in our history. With this realization the debate over health care in America comes into sharper focus. So do a lot of other debates.

Mike McCabe is executive director of the Wisconsin Democracy Campaign, a nonpartisan watchdog group working for clean, open and honest government. www.wisdc.org